Relation of periprocedural bleeding complications and long-term outcome in patients undergoing percutaneous coronary revascularization (from the Evaluation of Oral Xemilofiban in Controlling Thrombotic Events [EXCITE] Trial).

Abstract

Several clinical trials have shown that antagonists of the glycoprotein IIb/IIIa receptor decreased the incidence of death, nonfatal myocardial infarction, and the need for urgent revascularization when administered immediately before or during the 24- to 48-hour period after percutaneous coronary intervention (PCI). However, these agents increased the risk of thrombocytopenia and periprocedural bleeding complications. Therefore, the relation between periprocedural bleeding complications during PCI and long-term outcome was assessed in 6,995 patients in the EXCITE trial. Periprocedural bleeding was classified as none, mild, moderate, and severe. Measured outcomes included the incidence of all-cause mortality or the composite end point (cardiovascular disease) of death, myocardial infarction, or stroke. Subjects were followed up for a median of 210 days (7 months). Mean patient age was 59.1 years, and 21.8% were women. Periprocedural bleeding complications occurred in 1,869 patients (26.7%), and blood transfusion was administered to 189 patients (2.7%). In multivariate analysis, periprocedural bleeding complications were significantly associated with increased risk of the composite outcome for mild (hazard ratio [HR] 0.80, 95% confidence interval [CI] 0.64 to 0.97), moderate (HR 2.38, 95% CI 1.78 to 3.20), and severe bleeding complications (HR 3.55, 95% CI 2.20 to 5.73) during follow-up. Also, the necessity of blood transfusion was an important predictor of the composite end point (HR 2.61, 95% CI 1.96 to 3.60). Patients in the United States were more likely to be administered a blood transfusion than non-US patients independently of cardiovascular risk factors. In conclusion, moderate and severe periprocedural bleeding complications increased the risk of mortality and incident cardiovascular events after PCI.

• Authors: Jasper Jan Brugts, Nestor Mercado, Stephen Hu, Mimi Guarneri, Matthew Price, Richard Schatz, Paul Teirstein, William Wijns, Patrick W Serruys, William W O'Neill, Eric Boersma
• Journal: The American journal of cardiology (Am J Cardiol) Vol. 103 Issue 7 Pg. 917-22 (Apr 01 2009) ISSN: 1879-1913 [Electronic] United States
• PMID: 19327416 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)

Chemical References

• Benzamidines
• Platelet Aggregation Inhibitors
• xemilofiban

Topics

• Administration, Oral
• Angioplasty, Balloon, Coronary (methods)
• Benzamidines (administration & dosage, adverse effects)
• Coronary Angiography
• Coronary Artery Disease (diagnostic imaging, therapy)
• Coronary Thrombosis (epidemiology, prevention & control)
• Dose-Response Relationship, Drug
• Double-Blind Method
• Electrocardiography
• Female
• Follow-Up Studies
• Humans
• Incidence
• Male
• Middle Aged
• Platelet Aggregation Inhibitors (administration & dosage, adverse effects)
• Postoperative Hemorrhage (blood, epidemiology, etiology)
• Preoperative Care (adverse effects)
• Risk Factors
• Survival Rate (trends)
• Thrombocytopenia (blood, chemically induced, complications)
• Time Factors
• Treatment Outcome
• United States (epidemiology)